Diaper Rash Health Article

Definition

Dermatitis of the buttocks, genitals, lower abdomen, or thigh folds of an infant or toddler is called diaper rash. The outside layer of skin normally forms a protective barrier that prevents infection; when the barrier fails, the child may develop a rash in the area covered by the diaper. Diaper rashes occur equally with cloth diapers and disposable diapers.

Description

Diaper dermatitis results from prolonged contact with irritants such as moisture, chemical substances, and friction. Urine ammonia, formed from the breakdown of urea by fecal bacteria, is irritating to sensitive infant skin. Ammonia by itself does not cause skin breakdown. Only skin damaged by infrequent diaper changes and constant urine and feces contact is prone to damage from ammonia in urine. Inadequate fluid intake, heat, and detergents in diapers aggravate the condition. Bouts of diarrhea can quickly cause rashes in most children. Diaper rash begins with erythema in the perianal region. Left untreated, the area can quickly excoriate and progress to macules and papules, which form erosions and crust. Under certain circumstances (in infants under the age of six months, toddlers who have been on antibiotics, and immune compromised children) diaper dermatitis may become secondarily infected with Candida ablicans. Sometimes severe diaper dermatitis becomes super-infected with bacteria (streptococci or staphylococci).

Demographics

Diaper rashes occur in the diaper-wearing age group (birth to three years of age). Diaper rash occurs in about 10 percent of infants and is most common between the ages of seven and nine months. Some infants seem predisposed to diaper dermatitis. These infants have such sensitive skin that diaper dermatitis is a problem from the first few days of life.

Causes and symptoms

When parents and caretakers do not change the children's diapers often, feces is in contact with skin and irritation develops in the perianal area. Urine left in diapers too long breaks down into ammonia, a chemical that is irritating to infant skin. Ammonia dermatitis of this type is a problem in the second half of the first year of life when the infant is producing a larger quantity of urine.

When the diaper area has prolonged skin contact with wetness the natural oils are stripped away, the outer layer of skin is damaged, and there is increased susceptibility to infection by bacteria or yeast.

Frequently a flat, red rash resulting from chafing of the diaper against tender skin causes friction rash. This rash is not in the skin folds. It may be more definite around the edges of the diaper, at the waist and leg bands. The baby does not seem to experience much discomfort.

Sometimes chemicals in detergents contribute to contact dermatitis. These rashes should clear up as soon as the chemicals are removed. Ignoring the condition may lead to a secondary infection that is more difficult to resolve.

Another infectious cause of diaper rash is impetigo. This bacterial infection is characterized by blisters that ooze and crust.

When to call the doctor

Parents should call the child's healthcare provider for the following reason:

• newborn with rash looks or acts sick or has a fever
• rash looks infected (pimples, blisters, boils, weeping sores, yellow crusts, red streaks)
• rash is not better in three days after treatment for yeast
• rash bright red then peeling off in sheets or raw and bleeding
• rash beyond the diaper area
• rash painful and not responding to home care

Diagnosis

Diagnosis is made by examining the diaper area and taking the history of the onset and duration of the lesions.

The presence of skin lesions means the baby has diaper rash. However, there are several types of rash that may need specific treatment to heal. It is useful to be able to distinguish them by their appearance and causes.

A baby with a rash that does not clear up within two to three days or a rash with blisters or bleeding should receive an evaluation and care from a healthcare professional.

Treatment

Antibiotics are prescribed for rashes caused by bacteria and impetigo. This may be a topical or oral formula, depending on the size of the area involved and the severity of the infection.

Over-the-counter antifungal creams are often used to treat a rash resulting from yeast. If topical treatment is not effective, an oral antifungal is prescribed. Treatment of diaper candida in young infants should include oral drops to treat any candida in the mouth and gut to avoid re-infection.

Mild steroid creams, such as 0.5 to 1 percent hydrocortisone, may be used to treat seborrheic dermatitis and intertrigo. Prescription strength creams are needed for short-term treatment of stubborn cases. Intertrigo can be treated with a combination of hydrocortisone and anti-fungal creams.

Complication

The main complication is secondary infection by yeast or bacteria.